PENN STATE (US) — While electronic cigarettes may be an effective long-term alternative to smoking, questions remain about their long-term safety.

E-cigs consist of a cigarette-shaped device with a battery, a heating element, and a cartridge containing propylene glycol and nicotine. Users puff on the mouthpiece to activate a circuit that heats the atomizer and produces a vapor that is then inhaled.

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“If some smokers have difficulty overcoming both nicotine dependence and long-term habit change, then surely one solution is to help them avoid most of the health risks with only a minimal alteration in their nicotine-seeking habit,” says Jonathan Foulds, professor of public health sciences and psychiatry at Penn State.

“This implies a nicotine replacement device that looks like a cigarette and delivers nicotine like a cigarette, but does not deliver the tar and carbon monoxide that cause the vast majority of smoking-caused disease.”

A new study published in International Journal of Clinical Practice, found that 78 percent of long-term users were no longer using tobacco and planned on using their e-cig instead. Only 8 percent were using the most widely marketed style of cigarette-shaped e-cigs—most said they don’t deliver adequate nicotine and had researched online forums for products that worked.

“These products initially seemed to be something of a gimmick and likely to be banned by the FDA,” says Foulds. “However, they are continuing to be popular and at least some smokers appear to find them helpful. However, we just don’t have enough information on their long-term safety and effectiveness for clinicians to recommend them.

“Until that research has been carried out, I would advise smokers to use proven treatments. The treatments that have been proven to work include counseling (available at no cost by calling 1-800-QUIT NOW), nicotine replacement, bupropion, or varenicline.”

Foulds says poor quality control remains a problem. Some e-cigarettes that are sold as “high nicotine” appear to deliver very little nicotine. There are also concerns about the quality of labeling and instructions.

“I am particularly concerned that a child may be poisoned by drinking the flavored liquid designed for e-cigarettes,” Foulds says. “These types of products have the potential to help smokers to quit, but right now tighter quality control and regulation is needed.”

Foulds also notes the sample of e-cig users participating in the study were not representative of all e-cig users, but were a self-selected sub-sample of enthusiasts who have used the products, on average, for more than a year.